Psychometrics properties of the Iranian version of fertility quality of life tool: a cross- sectional study

Background: Clinical measurement of quality of life [QoL] for assessing reproductive problems should be considered as a standard investigation at the initial and continuing medical consultations with infertile people

Objective: The purpose of this study was comprehensive testing the psychometric properties of the Iranian version of fertility quality of life [FertiQoL]

Materials and Methods: This cross-sectional study was conducted on300 women referred to infertility clinic. After linguistic validation, a semi-structured interview was conducted to assess face validity. Consequently exploratory factor analysis was performed to indicate the scale constructs. Discriminate validity was assessed using the known groups comparison. Convergent validity was evaluated by assessing the correlation between similar content on the 12-Item Short Form Health Survey [SF12], Hospital Anxiety and Depression Scale and FertiQol. In addition, reliability analysis was carried out with internal consistency

Results: The reliability of the Iranian version of the FertiQoL was satisfactory in all dimensions [0.77-0.83]. Six factors [emotional, mind/body, relational, social, environmental, and tolerability] were extracted from the results of exploratory factor analysis. Discrimination validity showed that FertiQoL can differentiate between female patients with differing duration of infertility and number of children. Moreover, the results of convergent validity showed a favorable correlation between the related dimensions of SF12 [0.43-0.68], Hospital Anxiety and Depression Scale [0.47-0.52] and FertiQoL

Conclusion: The Iranian version of FertiQoL is valid and reliable for assessing infertility problems and the effects of treatment on QoL of infertile patients referred for diagnosis and treatment at infertility clinic

Facilitating and inhibiting factors related to treatment adherence in women with polycystic ovary syndrome: a qualitative study

Background: Adherence issues in polycystic ovary syndrome [PCOS] patients have not been examined thoroughly. Patients report prolonged periods of treatment and side effects of the drug as the most common reason for withdrawal from treatment. To improve the effective management of PCOS patients, it is fundamental to understand facilitating and inhibiting factors to treatment adherence

Objective: To explore facilitating/inhibiting factors related to treatment adherence among PCOS patients

Materials and Methods: This was a qualitative study with a purposive sample of women with confirmed diagnosis of PCOS. The data were collected via 20 in-depth semi-structured interviews with women aged between 21-34 yr. A qualitative content analysis was used to analyze the data

Results: Five themes were identified which described different types of facilitating/ inhibiting factors to treatment adherence. Inhibiting factors included financial issues, patient-related, disease-related, and health care provider-related factors; while social factors were found to be both facilitating and inhibiting

Conclusion: The findings suggest that successful adherence to PCOS treatment is highly dependent on patients recognizing and adapting to financial, social, and health care related inhibiting factors. It is also crucial for clinicians and policy makers to recognize these key inhibiting factors in order to improve treatment outcomes

Health-related quality of life in polycystic ovary syndrome patients: a systematic review

Increasing attention to the concept of polycystic ovary syndrome [PCOS] health-related quality of life has led to the development of tool that aims to measure this concept. The purpose of this study was to conduct a systematic review of psychometric properties of the PCOS health-related quality of life questionnaire. A search of database [Pubmed, PsychInfo, CINAHL, CENTRAL, Scopus and SID] from January1998 to December 2013 yielded 6152 references of which 27 papers remained after review of the titles and abstracts. The reviewers used structural tools to analyze the articles, critically appraise papers, and extract the data. Finally, eight papers met the full inclusion criteria. A search of database [Pubmed, PsychInfo, CINAHL, CENTRAL, Scopus and SID] from January1998 to December 2013 yielded 6152 references of which 27 papers remained after review of the titles and abstracts. The reviewers used structural tools to analyze the articles, critically appraise papers, and extract the data. Finally, eight papers met the full inclusion criteria. The PCOSQ/MPCOSQ showed acceptable content and construct validity, reliability and internal consistency. However, some other properties, particularly those related to factor and longitudinal validity, absolute error of measurement, minimal clinically important difference and responsiveness still need to be evaluated

impact of polycystic ovary syndrome on the health-related quality of life: a systematic review and meta-analysis

Polycystic ovary syndrome [PCOS] has been shown to cause a reduction in health-related quality of life [HRQOL]. However, the relative degree of impairment in each domain differed among samples, and it was not clear which aspect of disease-specific HRQOL [modified polycystic ovary syndrome health-related quality of life questionnaire] was most negatively affected. To systematically review the effects of PCOS on specific domains of HRQOL. Literature search using search engine of database [PubMed, PsychInfo, CINAHL, CENTRAL, and Scopus] between 1998 to December 2013 yields 6 relevant publications. Pairs of raters used structural tools to analyze these articles, through critical appraisal and data extraction. The scores of each domain of polycystic ovarian syndrome questionnaire [PCOSQ] or modified version [MPCOSQ] of 1140 women with PCOS were used in meta-analysis. The combine mean of emotional [4.40; 95% CI 3.77-5.04], infertility [4.13; 95% CI 3.81-4.45] and weight [3.88; 95% CI 2.33-5.42] dimensions were better, but menstruation [3.84; 95% CI 3.63-4.04] and hirsutism [3.81; 95% CI 3.26-4.35] domains were lower than the mean score of PCOSQ/MPCOSQ in related dimension. The meta-analysis showed that the most affected domains in specific HRQOL were hirsutism and menstruation. Based on these findings, we recommend healthcare providers to be made aware that HRQOL impairment of PCOS is mainly caused by their hirsutism and menstruation, which requires appropriate management

Frequency and severity of nausea and vomiting during pregnancy and its association with psychosocial health

The present study aimed to evaluate the frequency and severity of nausea and vomiting during pregnancy [NVP] and to investigate the association between psychosocial health and the severity of NVP. This cross-sectional study was performed on 200 eligible pregnant women with nausea and vomiting at three prenatal care centers in Kashan, Iran. The participants completed demographic and pregnancy-related questionnaire, Beck Depression Inventory-Short Form, Winnfield Tiygmann social support questionnaire and Paykel scale of stressful life events. the severity of NVP was also recorded. ANOVA and Kruskal-Wallis tests were used to determine the relationship between different variables. P-value less than 0.05 was considered statistically significant. The frequency of NVP was estimated at 71.5%. In total, 19%, 45.5% and 7% of these cases had mild, moderate and severe NVP, respectively. The severity of NVP was significantly associated with depression level [P=0.01]. However, there was no correlation between the level of social support and unpleasant life events with severity of NVP. According to the results of this study women with more severe NVP experienced a higher level of depression, compared to others. However, social support and other factors were not correlated with the severity of NVP

Pregnancy rate following luteal phase support in Iranian women with polycystic ovarian syndrome

To assess the efficacy of luteal phase support [LPS] using intravaginal progesterone [P] on pregnancy rate in Iranian women with polycystic ovarian syndrome [PCOS] who used a combination for ovulation induction consisting of letrozole or clomiphene citrate [CC] and human menopausal gonadotropin [HMG]. This was a randomized clinical trial undertaken in a fertility clinic in Kashan, Isfahan Province, Iran. A total of 198 patients completed treatment and follow up. Base on chosen ovulation induction programs, they were divided into two following groups: i. CC group [n=98] used a combination consisting of CC [100 mg x 5 day] and HMG [150 IU x 5 day] and ii. letrozole group [n=100] used a combination consisting of letrozole [5 mg x 5 day] and HMG [150 IU × 5 day]. After human chorionic gonadotropin [hCG] administration [5000 IU], the patients [n=122] who randomly received intravaginal P [Cyclogest, 400 mg daily] were included in LPS group, while the rest [n=123] were included in non-P cycles group. The outcome was the comparison of chemical pregnancy rate between the groups. Our findings showed that LPS was associated with a 10% higher pregnancy rate than in non-P cycles, although this difference did not reach statistical significant [p=0.08]. LPS improved pregnancy rate in both CC [4%] and letrozole [6%] groups. In addition, patients who used letrozole for ovulation induction along with intravaginal P showed higher pregnancy rates than CC group. Administration of vaginal P for LPS may improve the pregnancy rate in women with PCOS using letrozole or CC in combination with HMG for ovulation induction [Registration Number: IRCT201206072967N4]

Sexual functioning among married Iranian women with polycystic ovary syndrome

This study aimed to assess sexual functioning among women with polycystic ovary syndrome [PCOS] in Iran. A cross-sectional study was conducted to ascertain factors related to sexual functioning in 300 PCOS patients attending to the private practice centers in Kashan, Isfahan Province, Iran, from May to October 2012. The Female Sexual Function Index [FSFI] was used to measure sexual functioning. Moreover, the socio-demographic details and clinical information of PCOS including obesity, hirsutism, acne, menstrual cycle disturbances, infertility and endocrine profile were recorded for each patient. Overall the prevalence of female sexual dysfunction [FSD] was 16.6%. In particular patients indicated poorer sexual functioning for the desire [48.3%] and the arousal [44.7%] subscales. Multiple logistic regression analysis suggested patients with lower educational level [OR: 2.94; 95% CI: 1.46-5.92] and irregular menstrual status [OR: 4.61; 95% CI: 1.93-11] were more likely to report sexual dysfunction. The findings suggest that desire and arousal were the most prevalent sexual disorders reported in this patient population. In addition, findings suggested that women with limited or no formal education and a history of menstrual irregularities were the most likely to report female sexual dysfunction. Further investigations are needed to examine female sexual functioning among women with PCOS, to educate their health care providers, and to develop therapeutic interventions

Health-related quality of life and its relationship with clinical symptoms among Iranian patients with polycystic ovarian syndrome

Polycystic ovarian syndrome [PCOS] has been shown to cause a reduction in Health-related quality of life [HRQOL]. This study examines the extent of different clinical symptoms in PCOS patients on HRQOL. A cross-sectional study was undertaken to ascertain the factors related to HRQOL in 200 PCOS patients in Kashan, Iran. Main outcome measures were modified polycystic ovarian syndrome questionnaire [MPCOSQ] and clinical information of PCOS. Major clinical PCOS features including obesity [BMI], excessive body hair [hirsutism score], acne, menstrual cycle disturbances and infertility. Findings showed that the most common HRQOL concern was menstrual irregularities and infertility, followed in descending order by hirsutism, weight, emotion, and acne. Multivariate analysis revealed the menstrual irregularities as a significant predictor of menstruation [p=0.005], emotion [p=0.02] and infertility [p=0.02] subscales of the MPCOSQ. Having of infertility, predicted scores on the infertility subscale [p<0.0001]. Hirsutism score was a significant predictor of hirsutism [p<0.0001] and emotion [p<0.0001] subscales. Weight subscale concerns was predicted by BMI [p<0.0001], also, acne was found to be predicted score of acne subscale [p<0.0001]. Worsened HRQOL in women with PCOS was related to more menstrual irregularities and infertility than to obesity. The finding suggests a potential for poorer compliance with weight management protocols among affected PCOS patients.

Evaluation of female youth educational needs about reproductive health in non-medical students in the city of Qom

To evaluate reproductive health education which is essential to the prevention of sexual risk behavior and its associated adverse outcomes of unwanted pregnancy, AIDS and other sexually transmitted disease in adolescents. Little is known about youth educational needs about reproductive health in Iran. The aim of this study is evaluation of female youth educational needs about reproductive health in non-medical universities in the city of Qom, north central of Iran. The study was descriptive-analytical type conducted in nine non-medical universities [400 students]. A questionnaire was constructed to meet the purpose of the study based on similar studies of knowledge and attitude in different countries, yet it was modified according to Iranian culture and social norms. The findings showed that a majority of participants have moderate knowledge about all components of reproductive health. Approximately, one-third of the participants reported difficulties to discuss about sexual health with mothers. The most of the participants believed insufficient female youth reproductive health services and low knowledge about reproductive health were the main barriers for female youth reproductive health aims. The participants in this study are representatives of an important subgroup in Iran in order to evaluate female youth reproductive health educational needs. The study identified many misconception and negative attitude that need to be addressed. A health education program through parents, peers, mass media campaign and more comprehensive family planning curriculum in universities are recommended to overcome misconception and spread awareness

Iranian version of modified polycystic ovary syndrome health-related quality of Life questionnaire: Discriminant and convergent validity

A preliminary report indicated that the Iranian version of modified polycystic ovary syndrome health-related quality of life questionnaire [MPCOSQ] is a valid measure of health-related quality of life [HRQOL] in PCOS patients. Accordingly, the Iranian version of MPCOSQ was subjected to further psychometric analyses among a different sample of patients with PCOS. To examine discriminant and convergent validity of the Iranian version of MPCOSQ. This was a cross sectional study of 200 women with PCOS that was carried out in two private gynecology clinics in Kashan, Iran. Discriminant validity was assessed using the known groups comparison. Convergent validity was evaluated by assessing the correlation between similar content on the MPCOSQ and the SF-36. The mean scores for the MPCOSQ showed that women rated lowest on the infertility and menstrual subscales indicating worst health in these dimensions. The results from the SF-36 questionnaire indicated that emotional and vitality domains were the areas of poorest health. Known groups comparison showed that the MPCOSQ differentiated well between sub-groups of women who differed in PCOS specific symptoms, lending support to its discriminant validity. Convergent validity was assessed and as expected a good positive correlation was found between related subscales of the two instruments. The MPCOSQ has now been extensively tested in Iran and can be considered for using as an outcome measure in future outcome studies in this population

Body image satisfaction and self-esteem status among the patients with polycystic ovary syndrome

Most previous research has focused on polycystic ovary syndrome [PCOS] characteristics and their association with psychological disorders, such as anxiety and depression. In the present study, our aim was to study whether PCOS characteristics are associated with several aspects of psychological well-being namely self-esteem and body satisfaction. This was a cross-sectional study of 300 women with PCOS that was carried out in Kashan, Iran. Main outcome measures were the Body Image Concern Inventory [BICI] and the Rosenberg's Self-Esteem Scale and clinical information of PCOS. Major clinical PCOS features including obesity [BMI], excessive body hair [hirsutism score], acne, menstrual cycle disturbances and infertility. The findings of regression analysis indicated that infertile women had lower levels of self-esteem [beta=-0.11, p=0.049] and poorer body satisfaction [=0.121, p=0.036] compared with PCOS women without infertility. Furthermore, hirsute women experienced poorer self-esteem than women without hirsutism [beta=-0.124, p=0.032]. Women with menstrual irregularities had higher body dissatisfaction [beta=0.159, p=0.005]. Moreover, women with higher body mass index scores had poorer body satisfaction [beta =0.151, p=0.009] but were not associated with self-esteem. The emotional well-being of the patients presenting with the syndrome needs to be recognized more fully, particularly in relation to the low self-esteem, poor body image, and struggles with weight, menstrual irregularities, hirsutism and infertility. The results of this study raise implications for clinical practice and suggest that a multidisciplinary approach to the management of women with PCOS